The burden of asthma falls disproportionately on vulnerable groups including racial/ethnic minorities and children. Enhancing the clinical infrastructure for comparative effectiveness research in asthma and lung diseases will have high impact because there is a continuing dearth of information to address current medication choices for these priority populations. To reduce asthma morbidity, we also need to better elucidate the factors that affect prescribing and adherence to asthma controller medications in diverse populations. Specific Aims - We will: (1) Build an innovative infrastructure for research on asthma and lung diseases by creating and linking standardized datasets from a state Medicaid population and four health plan populations;(2) Compare real-world adherence to and effectiveness of the major asthma controller regimens in diverse populations;and (3) Conduct an applied methodologic study that compares different design and analysis approaches for observational comparative effectiveness research. Research Design - For Aim 1, we will create a new distributed data network for research in asthma and lung diseases by building on extensive, currently available computerized datasets from our diverse populations - the TennCare Medicaid population and four HMO Research Network sites. We will build on the HMORN's Virtual Data Warehouse `and approaches used by other successful networks. For Aim 2, we will conduct cohort and nested case-control studies using data from claims, electronic medical records (EMRs), and surveys of patients and providers. Aim 2 analyses will evaluate variations in the rates of adverse asthma outcomes and costs among the major controller regimens, using propensity score weighting and alternative methods to adjust for confounding by indication. For Aim 3, we will conduct a methodologic study that compares the generalizability and validity of various study designs and statistical analysis approaches, and evaluates the benefits of collecting patient-reported data. Impact. This project is innovative in its plan to include all four important data sources - claims, EMRs, patients, and providers - and a state Medicaid population in a new network for comparative effectiveness research on asthma and lung diseases. This large, diverse network will create a seminal model for comparative effectiveness research in chronic diseases and vulnerable populations. The current project will address key clinical and policy questions in asthma. The PEAL Network will lay a critical foundation for future population-based research in asthma and lung diseases, and research with priority populations. PUBLIC HEALTH RELEVANCE: Project Narrative This project will create a new infrastructure to accelerate comparative effectiveness research in asthma and other lung diseases in diverse populations. We will form the Population-Based Effectiveness in Asthma and Lung Diseases (PEAL) Network, creating highly detailed, standardized, linked computerized datasets from a state Medicaid plan and four health plans. We will conduct comparative effectiveness research on asthma controller medications, evaluating adherence and other real-world factors. This project is innovative in that we will link claims, electronic medical record, patient, and provider data, and will build new linkages with a Medicaid plan to include vulnerable groups who are disproportionately burdened by asthma.